[Liver enzymes elevation: etiologic study and efficiency of a single-act office visit]. / Elevación de las enzimas de función hepática en nuestro medio: estudio etiológico y de la eficacia de una consulta de acto único.

BACKGROUND: Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit. METHODS: From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist. RESULTS: A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients. CONCLUSIONS: The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started.

[Prevalence and associated factors to non-alcoholic steatohepatitis in obese patients subjected to bariatric surgery]. / Prevalencia y factores asociados a la esteatohepatitis no alcohólica en pacientes obesos sometidos a cirugía bariátrica.

INTRODUCTION: Non-alcoholic fatty liver disease has a high prevalence among obese patients. It has been difficult to identify clear predictors of chronic liver damage, which could help in selecting patients for liver biopsy and therapeutic options. The aim of the study is to describe the liver damage in these obese patients and identify predictors of liver damage progression. PATIENTS AND METHOD: 76 obese patients submitted to bariatric surgery were included. Liver biopsies were taken at the time at the time of the surgery. Clinical and biochemical variables were analyzed. RESULTS: 67 patients (88.1%) were found to have non-alcoholic fatty liver disease; 41 (61.2%) had simple steatosis, and 26 (38.8%) had non-alcoholic steatohepatitis. Patients with non-alcoholic steatohepatitis had significantly higher values of GGT. Non-alcoholic steatohepatitis was associated with diabetes (p < 0.01) in these patients. CONCLUSIONS: Non-alcoholic fatty liver disease is highly prevalent in morbidly obese patients. Non- alcoholic steatohepatitis seems to be associated with diabetes and high values of GGT in obese patients.